Provider Demographics
NPI:1720277239
Name:CENTRAL ASSISTED LIVING, LLC
Entity type:Organization
Organization Name:CENTRAL ASSISTED LIVING, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:MENDEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-471-7700
Mailing Address - Street 1:1509 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-4001
Mailing Address - Country:US
Mailing Address - Phone:718-471-7700
Mailing Address - Fax:718-337-3472
Practice Address - Street 1:1509 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-4001
Practice Address - Country:US
Practice Address - Phone:718-471-7700
Practice Address - Fax:718-337-3472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-21
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1344L001251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health